Scalp Psoriasis: What You Really Need To Know?

Dr. Ahmed Zayed

With any form of psoriasis, skin cells are attacked by their own immune system. New cells are added at a rate that is much too fast, and eventually this leads to an excess of abnormal skin that is irritated and inflamed.

Scalp psoriasis is the specific affliction of psoriasis occurring on the scalp, although it often spreads to the forehead, ears and neck as well. About half of those who have psoriasis also have scalp psoriasis. A tiny percentage of people have psoriasis of the scalp exclusively and never have the condition appear elsewhere on their bodies.

Common Symptoms of Scalp Psoriasis

Flaking of the skin, similar to dandruff only more silver in hue

Skin irritation, often severe

Red, irritated skin

Bumps

Dryness

Soreness

Bleeding

Hair loss, although temporary

Sores

Itching of the skin, ranging from minor to quite severe

Infection

Hair loss

The hair loss does not result directly from the psoriasis, but from the repeated scratching of the scalp. This will eventually aggravates the hair follicles and pulls the hair loose. In addition, certain medications during the treatment process can contribute to hair loss. Though a patient might be missing a considerable amount of hair after a bout with scalp psoriasis, it is only temporary and the hair typically grows back without any problems.

Treating Scalp Psoriasis

Topical Treatments:

In order to ease itching and irritation and avoid infection, it is crucial to get medicated relief into the scalp as soon as possible.

Skin scales need to softened and removed before treatment can be effective. Salicylic acid is a good choice for removing* scales, or there are scale-softening products available OTC. After applying the salicylic acid or softening agent, a soft brush can be used to gently loosen the scales before they are removed during shampooing.

Coal tar products (shampoos, gels, soaps) reduce* itching and inflammation and can slow down growth of skin and scales. Medicated and prescription shampoos are great to use, but it is important to use a conditioner afterwards so that the scalp has some moisture added back to it and isn’t further irritated.

Office Treatments:
Office Treatments – If the psoriasis is mild and limited to only a few areas of the scalp, a doctor will often opt to treat* the patient in his office by injecting steroid medicine directly into the affected areas

How is Severe Scalp Psoriasis Treated?

Persistent, severe psoriasis of any kind requires more drastic measures. With scalp psoriasis, however, it’s a different set of rules to play by.

For instance, phototherapy uses controlled exposure to UVA and/or UVB light sources in order to treat* psoriasis, and it’s extremely effective for severe cases. With scalp psoriasis, however, phototherapy isn’t an option unless the patient is bald or has extremely thinning hair because otherwise the UV light cannot penetrate the skin.

Systemic medication is used frequently with severe cases if scalp psoriasis. All of the drugs used are considered dangerous and carry a high risk factor for side effects and overall health. When a patient has existing psoriasis elsewhere on the body, it makes much more sense to use these drugs as it balances out the heavy risk factor and gives bigger overall benefit.

Retinoids – Vitamin A derivatives that reduce* skin cell production in the human body. Oral retinoid can cause severe liver damage, including hepatitis. There are significant birth defect risks, and women are advised to not get pregnant for at least three years after taking them.

Immunosuppressive Drugs – Methotrexate, Cyclosporine. Also called “Anti-Rejection” drugs, this class of medication was designed to inhibit the body’s immune system. Transplant patients are given Immunosuppresses so their bodies do not fight off a new organ. Because Psoriasis is an autoimmune disorder, doctors often turn to anti-rejection drugs when they have no other alternative.

Biologics – Biologic drugs are genetically engineered from protein. They can be considered similar in function to immunosuppressive because they target the immune system. With a psoriasis patient, a biologic drug would suppress* an immune system’s attack on its own skin cells. Biologics are injected into muscle tissue and are extremely expensive.

Additional Tips

Light clothes are the best choice to wear, since it will help hide any flakes that might show during the day.

Be gentle when shampooing. All forms of rubbing and scratching will only make the condition worse.

Shampoos containing mint have a tendency to irritate scalps.

Blow dryers will dry the scalp further and cause more irritation.

Use a “Five-Minute” rule with all topical creams and shampoos, leaving them on for a minimum of five minutes before rinsing.

Final Thoughts

Scalp psoriasis, like all forms of psoriasis, is physically unpleasant and frustrating to manage. The obstacle of hair and the thickness of the scalp itself make it difficult to treat*. Treatment options are different as well.

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Dr. Ahmed Zayed Helmy holds a baccalaureate of Medicine and Surgery. He has completed his degree in 2011 at the University of Alexandria, Egypt. Dr. Ahmed believes in providing knowledgeable information to readers. Other than his passion for writing, currently he is working as a Plastic surgeon and is doing his masters at Ain shams University.

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